No more bets, please: evaluating the fall in nursing applications

Image: IKON

When the abolition of NHS bursaries was announced in November 2015, my article for Wonkhe described the policy as a “gamble”. With the news last week that application figures for nursing courses have dropped by 23% for 2017 entry, you might conclude that the gamble has failed.

However, applications are only part of the story, and, just as one swallow does not make a summer, nor, necessarily, does the loss of one hand of cards mean a gambler has run out of luck.

Responding to the UCAS announcement, the Council of Deans for Health (COD) and Universities UK were keen to stress calm: they expected application numbers to fall in the first year of the new funding arrangements; they expect them to rise again in future years; and other factors unrelated to the policy shift have contributed to the decline. Most importantly, they argue, there will still be enough applicants to fill places on courses, given how oversubscribed healthcare courses were under the old commissioning system.

That the COD and UUK would want to downplay the decline in applications is understandable. After all, they not only supported but lobbied strongly for bursaries to be abolished and loans introduced ahead of the 2015 spending review, submitting detailed proposals to HM Treasury and issuing a public statement calling for change. Any perceived success or failure will, inevitably, reflect upon them. Even so, it was HM Treasury and the (rather more reluctant) Department of Health (DH) who acted on those demands, and the ultimate responsibility for the policy lies with them.

In the six years that David Cameron was PM, his administration had a habit of announcing student finance policy changes without thinking them through: the National Scholarship Programme, the reforms to Disabled Students’ Allowances and even the abolition of maintenance grants were all initiatives launched prior to any detailed consideration of either the design or the implications of the new arrangements. The signs that the abolition of NHS bursaries conformed to this pattern were there from the outset. George Osborne declared scrapping bursaries for nursing students would create 10,000 new places by 2020. He seemed unaware that the policy affected other professions, and the DH could never justify the 10,000 figure adequately: the best it could do was make a brief reference to it being based on ‘historical commissioning numbers’ – not an immediately obvious link – when it published its impact assessment the following April.

Meanwhile, the DH minister then responsible, Ben Gummer, insisted that, as the post-Browne reforms were a ‘success’ for other undergraduates, they would work for healthcare students – regardless of the fact that the student profile and course structures are very different, and even though the effect of scrapping maintenance grants was (is) yet to be understood. When London Economics produced detailed research predicting a decline in student numbers arising from the changes, the DH said simply that it did not recognise the analysis (it may be feeling more familiar now).

In other words, the government pressed ahead, having made a number of contestable assumptions, and set itself a target for recruitment that may have been more aspirational than it was evidenced. To return to the gambling metaphor, a lot of chips were on the table.

Leaving aside whether or not the fall in applications this year was predictable, will the bet still pay off? Should we be relaxed for the reasons the COD and DH advance? To take the three main contentions in turn.

Universities will still recruit enough qualified applicants

Hitherto, a large proportion of individual applicants for healthcare courses – over half according to Osborne – did not secure a place. Therefore, a drop in applications does not necessarily mean there won’t be enough applicants to maintain current numbers; with no cap on places it may still be possible to increase numbers. However, the figure for excess applicants did not distinguish between those who were suitably qualified and could not get a place, and those who did not meet one of the various criteria: academic qualifications, literacy and numeracy, values-based recruitment, DBS checks and so forth.

Unison collated figures via FOI requests to nine universities, which suggested that, on average, only 18% of applicants were suitably qualified. No doubt some qualified applicants did not get places under the old system, but there may be much less of a buffer than the headline figures suggest. Some small and specialist healthcare professions are especially vulnerable.

Two other factors may come into play. The new arrangements open up competition: given the freedom to expand the places they offer, some institutions may well find numbers hold steady or rise – but this could be at the expense of neighbouring institutions rather than expanding numbers overall. Second, the information campaign around the changes has been very limited (more on this in a moment) and we cannot assume that everyone who has applied understands that the system has changed and how it affects them, especially when the complex interaction with the benefits system is critical for many of those applying. For some claiming benefits the increase in loans will mean less money during their studies, not more. An unknown number may yet choose not to progress onto a course when this becomes clear.

Application figures will rise again next year

Given application figures dipped ahead of entry to other courses when fees rose in 1998, 2006 and 2012, only to then recover, the DH is ‘confident; that healthcare course applications will too. There are two main reasons to be cautious about this assumption. First, the decline in applications in each of those years was preceded by a spike in applicants for entry the year before, as individuals sought to avoid the relevant fee rise. There was no such spike for healthcare courses in 2016 (the policy only being confirmed last summer) so this decline doesn’t include any reversion to the baseline.

Secondly, it is simplistic to assume that prospective healthcare students will react in the same way to changes in finance as other undergraduate students. In 2015, overall applications for entry exceeded the previous high-water mark of 2011, the year before fees rose to £9,000 – but applications by mature students, who make up a high proportion of healthcare student numbers, were still lower (albeit higher than in any year since 2012) and they have decreased again this year. Add to this the decline in the number of 18-year-olds in the wider population, to say nothing of the continued decline in part-time numbers, and it is clear that just assuming there will be a swift recovery in numbers is unwise.

Other factors are at play

Policy changes rarely occur in a vacuum, and funding systems alone won’t explain the drop in applications. For example, mature and EU student applications have dropped across the board, for various reasons. The COD points out that some may have applied to nursing associate apprenticeship places rather than degree courses – but if students are doing so because of the funding arrangements alone, that risks a problematic situation where some, likely poorer, students choose the associate route to avoid debt, while others take up degree routes into better paid roles. The COD themselves have expressed concern that the introduction of associate roles will dilute the number of registered nurses.

Another issue that hasn’t been raised is communication. The Departments for Education and Health have been notably ineffective at explaining the changes: the regulations bringing healthcare students into the DfE system still haven’t been laid before Parliament; the minor modifications to the system to provide additional hardship and childcare funding for healthcare students still haven’t been fully explained; and there has been no adequate attempt to publicise what has changed and how it will work. Information alone will not overcome the objections of some students to the new arrangements, but these failings will have been damaging.

None of this is to say definitively that student numbers will decline when courses begin in the autumn – but nor can such a steep fall in application numbers be simply dismissed either, and a fall in numbers is very possible. It’s not surprising that the government and the sector wish to avoid a narrative developing that the reforms have failed – but in refuting this, they must not be too sanguine, and rely too heavily on optimistic assumptions. The stakes are much too high for students, universities, ministers and the public alike.

2 thoughts on “No more bets, please: evaluating the fall in nursing applications”

  1. An interesting article. It is a bit of a shame that some attention hasn’t been devoted to the national differences in the figures – given the policy differentiation. The Wales figures are different and show that while applications have fallen, they haven’t done so by anywhere near as much as in England. Wales (for now) retains the bursary.

    1. David Malcolm says:

      Unfortunately I didn’t have the space to go into national differences, but I’d very much agree it’s worth analysing. Applications have also fallen, but only slightly, in Scotland, though in Northern Ireland the fall is closer to that in England, despite no changes there either, so there’s clearly various factors at play. In respect of Wales, I wonder if confusion over the changes in England and whether they applied to Wales (see my point about information above) might have depressed Welsh applications despite the bursary remaining in place there, especially given the higher cross-border flows between Wales and England. Impossible to know at this stage but I would guess it has played a part.

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